Roots of crisis lie in lack of Consultant numbers caused by rising emigration from a chaotic working environment

Monday 14th September 2015.  The Irish Medical Organisation (IMO) has criticised what it has called “inflammatory” remarks on consultants made today by the Minister for Health on the crisis in Emergency Departments.

Speaking today, Dr Peadar Gilligan, Chair IMO Consultant Committee said that Consultants were working under enormous pressure and were amongst the front line workers who were bearing the brunt of the crisis in our health services. Dr Gilligan also pointed out that under the 2012 work practice agreements all consultants can be rostered for a 5/7 service to include weekends and in addition agreement was reached between the IMO and the HSE in relation to delegated discharge at the weekends so as to allow patients to be discharged over the weekends.  Dr Gilligan said it was not the case that consultants need to change their work practices – the problem is that there are not a sufficient number of consultants in the public health system to allow for an ongoing 24/7 consultant delivered service added to the problems created by insufficient physical capacity in the system to support 24/7 rosters including beds, theatre time and diagnostic services.

Dr Gilligan said; "Consultants already work over and above their contractual hours and have positively engaged with work practice changes but they cannot be held accountable for a system that simply does not have enough doctors in the system to work the rosters.  Similarly consultants responded positively to delegated discharge at weekends but the HSE, yet again, have failed to progress and implement this measure."

The Minister has said that money and staff will not solve the ED Crisis but that is simply not correct.  Speaking today Dr Gilligan, Chair of the IMO Consultant Committee said “adequate planned resources and more consultant staff will go a long way to solving the crisis but this Government continues to pursue policies that drive doctors away from Ireland, fails to recruit our trainees back to Ireland and allows our public health services to fall apart under the burden of increased demand and reduced resources.  Giving insufficient resources to a problem that requires long term funding across the system will not yield tangible results. Doctors are not to blame for bad policy, bad planning and lack of resources”.

Dr Gilligan said; "The issues behind the ED Crisis require long term planning, substantial long term investment and a real commitment from Government to tackle what is no longer a crisis but an ongoing reality.  We must deal with the core issues of:

Increased capacity in the Acute Hospital System: Since 2007 the number of acute beds has fallen by over 13% while ED attendances and admissions have increased.  An additional 300 beds is not sufficient.

Long Term and rehabilitative care for elderly patients: Failure to move patients from acute hospitals to appropriate settings increased costs and reduces efficiency. With an ageing population this problem is growing year on year as Government fail to fully fund appropriate measures.

Acute Medicine Programmes: The Acute Medicine Programme was established to prove an alternative pathway for patients allowing their GP to directly refer patients to the AMU.  Lack of capacity and funding in the acute hospital system means the AMUs now serve as an extension to the ED.

Lack of investment in Chronic Care Management in General Practice: Many attendances at ED are as a result of chronic care problems.  If General Practice was properly resourced to provide chronic care programmes this would over time reduce ED presentations."

Ends